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BACKGROUND: The aim of this study was to identify factors associated with postoperative complications and to evaluate whether the severity of postoperative complications as classified using the Clavien classification was associated with cancer recurrence and survival.

METHODS: The records of all patients who underwent an esophagectomy for cancer between 2002 and 2007 were reviewed. Postoperative complications were graded using the Clavien Classification, and scored from minor (GradeI) through the most serious (GradeIV). We defined major complications as those ≥ Grade IIIb.

RESULTS: The study population consisted of 422 patients with a median age of 63 years. Neoadjuvant therapy was given in 94 patients (22%). En bloc, transhiatal and minimally invasive esophagectomies were performed. Post-operative complications occurred in 191 patients (45%). Complications were considered minor (Clavien Grade I-IIIa) in 116 (27%) and major (Grade IIIb or IV) in 75 (18%). On multivariate analysis, increasing age, stage, blood transfusion and Clavien classification ≥ Grade IIIb complications were independent negative predictors of survival. Factors associated with cancer recurrence included tumor stage, blood transfusion and major postoperative complications. Factors associated with Clavien Grade IIIb or higher complications included increasing age and blood transfusion. Neoadjuvant therapy, tumor stage and type of resection were not associated with postoperative complications.

CONCLUSION: The study suggests that in addition to known prognostic factors such as tumor stage, the occurrence of major complications are associated with a higher frequency of recurrence and decreased survival after esophagectomy for cancer. Esophagectomy should be done in experienced centers where major complications are minimized.